Provider Demographics
NPI:1821143553
Name:RAFF, SUANN RAYLENE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:SUANN
Middle Name:RAYLENE
Last Name:RAFF
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3853
Mailing Address - Country:US
Mailing Address - Phone:918-540-1715
Mailing Address - Fax:
Practice Address - Street 1:2301 S EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1009
Practice Address - Country:US
Practice Address - Phone:918-675-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist